What is Dacryoadenitis?
This condition is an inflammation of the lacrimal glands in the eyes. Some basic anatomy of its location would perhaps help us more to better understand the nature of the condition. The lacrimal gland is situated in the supratemporal orbit wherein both the orbital and palpebral lobes are found. Dacryoadenitis can be acute or chronic.
The symptoms for acute dacryoadenitis are the following:
- Sever pain, redness, and pressure on one side of the supratemporal region
- It is characterized by a rapid onset which lasts from hours to days
- Often involves the palpebral lobe, which is seen as prolapsed and enlarged when the upper lid is everted
- Swelling of the conjunctiva
- Mucopurulent discharge
- Restricted ocular movement
- Parotid gland enlargement
- Fever and malaise
- Infection of the upper respiratory tract
The symptoms for chronic dacryoadenitis are the following:
- Unilateral or bilateral painless enlargement of the lacrimal gland which has been present for more than a month already
- This is more common than the acute type and has less severe manifestations
- Minimal ocular signs
- Mild ptosis or drooping of the eyelid, which is secondary to enlarged gland
- Dry eyes which is mild to severe
The causes of dacryoadenitis can either be infectious or inflammatory. Under infectious, it can be caused by a virus, a bacterium, or by a fungus.
The viral causes are as follows:
- Epstein-Barr virus (EBV) – this are part of the herpes virus family
- Herpes zoster or shingles, which is a recurrence of chickenpox
- Mononucleosis, which is also caused by EBV
- Echoviruses that are found in the gastrointestinal tract, making it part of enterovirus
- Cytolytic coxsackie virus A, an enterovirus that causes hand, foot, and mouth disease in childhood characterized by fever and painful blisters on the mouth, the palms, and the soles of the foot
The bacterial causes of the infection include the following:
- Staphylococcus aureus, which are gram-positive coccal bacteria that cause simple skin infections to life-threatening pulmonary conditions
- Neisseria gonorrhoeae that are responsible for sexually transmitted diseases (STD)
- Treponema pallidum are group of bacteria that have subspecies that can cause syphilis and other treponemal diseases
- Chlamydia trachomatis, an intracellular pathogen affecting both men and women resulting to urethritis, proctitis, trachoma, and infertility. In men, it causes prostatitis and epididymis. In women, it causes cervicitis, pelvic inflammatory disease (PID), and ectopic pregnancy
- Mycobacterium leprae, also known as Hansen’s coccus spirally and is common in tropical countries, is the bacteria that cause leprosy
- Mycobacterium tuberculosis is the most common causative factor of tuberculosis
- Borrelia burgdorferi is a gram-negative bacteria that is the causing agent of Lyme disease
The inflammatory causes of dacryoadenitis are as follows:
- Sarcoidosis – this is an inflammatory multi-system disease which has ophthalmologic manifestations
- Graves’ disease
- Sjögren syndrome – this is a chronic inflammatory condition and is characterized by lymphocytic infiltration of the lacrimal gland leading to keratoconjunctivitis
The treatment of dacryoadenitis varies based on its etiology and the onset of the disease. For viral causes of acute-onset dacryoadenitis, this is the most common and is usually self-limiting, meaning it will just disappear on its own. Supportive measures can be used such as warm compresses and oral NSAIDs (non-steriodal anti-inflammatory drugs). For bacterial causes, cephalosphorins is given initially until the result of the culture is obtained. Inflammatory or non-infectious causes should be checked thoroughly and treat based on the underlying condition.
For chronic type of dacryoadenitis, the best management is to identify the causative factor and treat the underlying condition. If the enlargement will not disappear after two weeks or at least if there’s no relief of symptoms, proceed with lacrimal gland biopsy.
The medications commonly useful in this condition are cephalexin and cefazolin because they provide a broad coverage in the treatment of both gram-negative and positive organisms that cause dacryoadenitis.
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